ORDERS:
ORDER
STATEMENT OF THE CASE
This matter is before me
pursuant to the appeal of Betty J. Pitts (Appellant), from a final decision of
the Respondent, South Carolina Department of Health and Human Services
(Department), denying the Appellant’s application for Medicaid benefits under
the Aged, Blind or Disabled (ABD) program. The Administrative Law Court (ALC)
has jurisdiction to hear this matter pursuant to S.C. Code Ann. § 1-23-600 (2005).
On April 4, 2006, the Department filed a Motion to Dismiss this case.
Appellant did not respond.
STANDARD OF REVIEW
As set forth above, this case is before the
Division as an appeal of an agency action pursuant to S.C. Code Ann. § 1‑23‑600(D)
of the Administrative Procedures Act (APA) upon appeal from a Final Order of
the Department. As such, the Administrative Law Judge sits in an appellate
capacity under the APA rather than as an independent finder of fact. In South Carolina, the provisions of the APA -- specifically Section 1-23-380(A)(6) -- govern
the circumstances in which an appellate body may review an agency decision.
That section states:
The court may reverse or modify the decision if substantial
rights of the appellant have been prejudiced because the administrative
findings, inferences, conclusions or decisions are:
(a)
in violation of constitutional or statutory provisions;
(b)
in excess of the statutory authority of the agency;
(c)
made upon unlawful procedure;
(d)
affected by other error of law;
(e) clearly erroneous in view
of the reliable, probative and substantial evidence on the whole record; or
(f) arbitrary or capricious
or characterized by abuse of discretion or clearly unwarranted exercise of
discretion.
S.C. Code Ann. § 1-23-380(A)(6) (2005).
DISCUSSION
Factual/Procedural Background
Appellant applied for Medicaid benefits under the
ABD program from on August 29, 2005. Upon referral to Respondent’s agent,
South Carolina Department of Vocational Rehabilitation (VR), for disability
determination, no evaluation was performed because the Social Security
Administration (SSA) had made a disability determination within 12 months of
the application date and denied Appellant’s application for disability. VR
found that Appellant’s Medicaid application allegations were the same
allegations made in his SSA application. The DHHS Hearing Officer found that pursuant
to Federal law, 42 USC 435.541 (a) and (b), the Department was without
authority to issue a decision inconsistent to the SSA determination.
Law/Analysis
Respondent argues in his Motion to Dismiss that
when SSA has made a determination of no disability, the Department may not make
an independent finding on that same issue since the SSA determination is
binding. 421 CFR 435.541(b)(1) provides that Effect of SSA determinations an
SSA disability determination is binding on a state agency until the
determination is changed by SSA unless the applicant establishes an exception
set forth in Section 435.541(c)(3). See also: Sebastian v. Commissioner of
Human Services, 1993 WL 642701 (M.D.Tenn. 1993) (“Specifically, if the
Social Security Administration (“SSA”) has made a determination of
non-disability for SSI benefits purposes, then the state agency must defer to
this decision and cannot re-determine Medicaid eligibility on disability
grounds if SSA and the state have a section 1634 agreement. . . .”). In fact,
under these federal regulations “the federal agency’s determination of
nondisability supercedes [even] a previous state agency determination of
disability.” Disabled Rights Union v. Kizer, 744 F. Supp 221, 224 (Cal. 1990).
Here, the evidence shows that SSA made a ruling
on Appellant’s application within twelve months of Appellant’s Medicaid
application and that the same allegations for disability were made in both
applications. Appellant has not provided any reason at the hearing below or to
this court why her prior SSA determination would not be binding pursuant to
Regulation 435.541 (c)(3). Therefore, the Hearing Officer was without authority
to issue an inconsistent ruling.
IT IS
THEREFORE ORDERED that this appeal be dismissed.
AND IT IS SO
ORDERED.
______________________________
Ralph
King Anderson, III
Administrative
Law Judge
May 8, 2006
Columbia, South Carolina |
